Southern Districts Basketball
U12 Talent Identification Program
Athlete Name
*
First Name
Last Name
Athlete Gender
Please Select
Male
Female
Non specified
Athlete DOB
-
Month
-
Day
Year
Date
Day/s Attending
Please Select
Monday 20th January only
Tuesday 21st January only
Both Monday 20th and Tuesday 21st January
Reversible Singlet Size
Please Select
Youth Size 8
Youth Size 10
Youth Size 12
Adult XS
Adult Small
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Primary Contact Name
*
First Name
Last Name
Primary Contact Email
*
example@example.com
Primary Contact Mobile
*
Please enter a valid phone number.
Relationship to Player
*
Secondary Contact Name
*
First Name
Last Name
Secondary Contact Email
example@example.com
Secondary Contact Mobile
*
Please enter a valid phone number.
Relationship to Player
*
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PAYMENT
Payment is required to confirm registration in U12 Talent Identification Program
My Products
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Categories:
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( X )
2 Day Talent Identification Camp including reversible singlet
$
200.00
AUD
1 Day Talent Identification Camp including reversible singlet
$
130.00
AUD
Spartans Basketball (Size 5)
$
45.00
AUD
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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